Title: College of the Overwhelmed
1(No Transcript)
2Staying Healthy at TuftsStudent Mental Health
and Success
- Richard Kadison M.D.
- Chief, Mental Health Service
- Harvard University Health Service
3Challenges
- Reduce Stigma, Manage Stress
- Convince Universities that health and counseling
resources are wise investments - Coordination of care between health, counseling,
residence, faculty, and administration - Integrating Cultural Sensitivity and competence
into our work
4Current issues
- Integration of Academic Work with student health
and development - EVERYONE on campus is responsible for student
well being. - Coordination of care
- More serious mental health problems on campus.
Helping high risk students
5Stress on Staying Healthy
- Eat, Sleep, Exercise
- Stay connected with friends/ community
- Provide tools to manage stress
- Educate community to reduce stigma thru education
about common problems and how to recognize
warning signs. - Create multiple portals of entry to care
6Staying Healthy
- Stressing Personal and professional Development
- Service Opportunities Engaged Learning
- Health Education and Information (MRSA)
- Alcohol and Nutrition info (BAL BMI)
- Complementary Services Acupuncture, Massage,
Yoga, Mindfulness
7Student Participation/ Engagement
- Key for Successful Outreach
- Peer Counseling/ Education Programs
- Student Health Advisory Group
- Wellness representatives in the dorms
- Mental Health Advocacy Group/Active Minds
- Involve in screenings and education
8Getting Care
- Multiple ways to access care
- Chaplains, Advising system, residence system
- Information about resources and warning signs for
parents and families - Stress relieving events and workshops at high
stress times (massage, food, activities/
workshops)
9Access to Care
- Triage system Who needs to be seen today
- Inside vs. Outside Care
- Community Resources
- Hospital and Medical Leave, Reentry
- When should students go home? How to decide
- Teach Wellness Eat, Sleep, Exercise
10Lessons from Virginia Tech
- Students in distress often dont seek or avoid
care - When students are mandated for assessment,
there must be follow up and clear consequences - When students return from hospital care, a
careful internal review process is critical
11Lessons from Virginia Tech
- Violence is very rare and difficult to predict
(prior violence best predictor) - There must be a community effort to reduce
stigma, recognize risk factors, and find portals
to care. Educate everyone - Counseling and Health Services can and should
provide consultation to the community (students,
faculty and staff)
12Lessons from Virginia Tech
- Schools must find ways to respect medical
privacy, but coordinate concerns - If students cant expect privacy, they wont seek
care - There must be communication, sometimes one way,
between faculty, administration, family,
counseling when concerns arise about a student - FERPA and HIPAA
13Youth Risk Survey 2001 13,600 HS students
- 28.3 sad or hopeless almost every daygt 2 wks
stopped some activity due to symptoms - 19 percent of students reported that they
seriously considered attempting suicide - 14.8 percent had made a specific plan to attempt
suicide. - 8.8 percent had attempted suicide in the previous
year Grunbaum et al 2002.
14College Data ACHA and Kansas State
- Depression Doubled, Suicidal Ideation Tripled,
Sexual Assaults quadrupled over 13 years - 45 students self report depression
- 10 report serious suicidal ideation and 44
binge drink - These are the best years of your life
15ACHA College Data
- 9 seriously consider suicide 1 attempt
- Depressed 52-42 2000/2006
- No Sexual partners 40 vs. 5 perceived
- Medication for depression 36-42
16Graduate Students
- Often at higher risk, higher suicide rates
- Economically in worse shape, many have no
insurance. - Berkeley Graduate Student Mental Health Survey
Dec. 2004 showed similar findings to undergrad
surveys
17Berkeley Grad School Survey
- 45.3 respondents experienced emotional or stress
related problem SIGNIFICANTLY affected well
being/ academic performance - 9.9 seriously thought about suicide
- 52 considered using counseling less than 33 did
use - 25 unaware they were available
18 Learning from Each Other
- Peter Leviness undergraduate student survey
engaged students to highlight and address campus
stress U. Richmond - Jan Collins-Eaglin 1st. Generation,
multicultural students need language for therapy,
Wayne State - Ron Chapman Pre and post counseling GPA changes-
increased 1.0 BYU
19Stories to Spread the Word
- Educate the community to reduce Stigma College
Wide Events - Being Depressed at HBS
- Walk the walk of the student on your campus
illness in family, high fever, serious alcohol
problem. How do you get help? Web?
20Healthcare 2007
- BIG changes in the last decade
- Severity of Problems of students making it to
college - Managed Care Shorter Hospital Stays and more
alternative treatments - Reduced outpatient community resources
- Higher insurance costs for students
21 Impediments to Academic Success
- Stress 32.4
- Cold/Flu 25.6
- Sleep Problems 24.6
- Depression 15.3
- Internet Use/ Games 13.4 (3-6 of students
addicted to internet pornography 20 are women)
22Sleep Problems
- 35 of adult population experience insomnia
- 11 of college students get a good nights
sleep - Loss of cognitive functioning, driving
- Increased risk of depression
- lt 7 hours yields sleep deprivation
23Common Problems
- Developmental Adjustment, Relationships
- Depression
- Anxiety
- Eating Disorders
- Bipolar Disorder
- Acute Psychosis
- Substance Abuse
24High Risk Issues
- Eating Disorders
- Dual diagnosis Substance Abuse/ depression
- Bipolar Illness and Psychosis
- Reentry from Hospitalization
25Eating Disorders
- Anorexia, Bulimia, EDNOS
- 1 Anorexia, 3-5 Bulimia, 15-20 DE
- 5-15 mortality from anorexia
- 1/3 of people dont improve from serious anorexia
26Substance Abuse
- Binge Drinking- 5 or more drinks one sitting in
past 2 weeks - 44 meet criteria in national surveys
- 41 did something they regretted
- 31 forgot what they did
- 9.7 unprotected sex
- 17 physically injured
27Substance Abuse
- Dont stigmatize medical services. Separate from
Judicial - BASICS Motivational interviewing and education
shows best results with reducing high risk
drinking - Consistent enforcement policies and consequences
for students with identified AODS team on campus
28Stimulant Abuse
- 900 increase in production of methylphenidate
(Ritalin) 1990-2000 - 3-7 school age kids ADHD
- 50 carries over into college
- 16 use recreationally by mouth, snorting or by
injection 30 share
29Suicide
- Long Term Risk factors
- Prior attempts
- Feelings of hopelessness
- Suicidal plan, isolation, prior attempts
- 10 attempters die over 10 years
- 45 of 76 suicides occurred during first week post
hospitalization
30Legal Issues
- Shin case settled but issues unresolved
- Virginia Tech Refusal of care by student
- George Washington, Hunter College student
dismissals - Allegheny College Suicide
31Legal Issues
- Handbook Language for Notification/LOA
- Medical Privacy Laws very strict
- FERPA (Family Education Rights and Privacy Act)
HIPAA - Prohibits disclosure of education records
- Permits disclosure gained through observation
- Permits disclosure of safety emergency
32Leave of Absence and Return
- Students rarely want to take time off, but may
need to - When students return, important to review their
readiness to be back at school internally - Contracts and Riders
33Retention
- 562 students asking for counseling followed over
2 year period - 0 sessions 65 1-12 79 gt13 83
- Several studies followed people over 5 years all
showed dramatically higher retention rates,
averaging more than 10 for students who used
counseling services - Steve Wilson, Terry Mason, Evaluating the impact
of receiving university based counseling services
on student retention - Journal of Counseling Psychology 1997 vol 44. no
3 p. 316-320
34Retention
- Social Isolation single most important
determinent of dropout rates Pascarella and
Terrazini, 1979 - Emotional- Social Adjustment items predicted
attrition better than academic items Gerdes and
Mallinckrodt 1994 - 5 year study of Berkeley students and those
making use of counseling had higher graduation
rates Frank and Kirk 1975
35Medication
- Polarized attitudes of students and staff
- Antidepressants benefits and risks (bipolar) and
side effects - Sleep Medications
- Anxiety Medications
- Stimulants Newer preparations
- Role with disabilities and judicial issues
36Medication
- Antidepressant and Stimulant Safety Controversy
- Reduction of 20 in prescribing since black box
warning - Most prescribed medications on college campuses
12 of pharmacy budget for antidepressants - Side Effects Kiss of death
37Multicultural Students
- Present emotional problems physically
- Metabolize medications differently
- May be more comfortable with Pastoral Resources
follow path of least resistance - Vulnerability in language/cultural adjustment and
symptom presentation - Staff sensitivity to cultural beliefs
38Diversity Considerations
- Create a culturally competent community
- Learn and respect different values and cultures
- Celebrate the diversity of your community by
events that encourage sharing art, music, and
other traditions. - Diversity may be via culture, race, ethnicity,
sexual orientation, economics
39Coordination of Care
- Handbook expectations who gets notified about
hospitalization/ return - Identifying high-risk students
- How is residence involved with worrisome
students? - Eating Disordered or Substance Abusing students
in residence, what happens? - Contracts When to invoke them
40Parents
- 70-80 of students get their health information
from their parents - They often feel they are supposed to let go of
students and need help staying engaged without
being intrusive - Help helicopter parents teach their students to
fish and become emerging adults
41What Must We do?
- Engage our students in the community Life is
richer and more satisfying for students who are
engaged in learning - Stress Health and Wellness on campus and create
opportunities for connections
42Wellness Activities
- Engage Students in community- study breaks,
hikes, encourage student groups - Teach yoga, sleep hygiene, mindfulness,
relaxation response - Have annual wellness or caring events like this
one or maximize academic potential, minimize
stress - Student Wellness Reps.
43Coordinating Board
- All stakeholders Students, Financial and Student
Service Deans, Residence, Public Safety,
Ministry, Health, Counseling, Disability - Community wide programs for education from top
down and bottom up set priorities!
44Coordinating Board
- Advisory to Counseling/MH
- Strategic, Realistic Planning
- Community vs. Individual needs Insurance
- Consider having regional meetings with
shareholders in other area schools to share good
ideas and increase leverage with local medical/
community resources
45Web Information
- Online screenings Mentalhealthscreening.org
ULifeline.org - Information/education about alcohol
- Student made DVD to incoming students
- Information about resources
- Many good web resources (JED (Ulifeline),
Mystudentbody.com, Alcohol.edu) - Launching mentalhealth.edu
46Summary
- Emotional and Physical Well-Being are crucial for
Academic Success - We all have to work together
- Focus on Staying Healthy and Learning Healthy
Lifestyles Eat, Sleep and Exercise